Hi Amanda,
There is something going on - i see your note in the comments section this morning that she vomited last night. Did the vet check her for pancreatitis? The link to read up on that is here in the
"where can I find?" post, click on the New to the Group Sticky, scroll down to the single topic posts at the bottom and look for "Primer on Pancreatitis."
One reason the BGs are so often lower at night is because in the early morning hours, all diabetics have a hormone release called
"Dawn Phenomenon." That is responsible for the higher day cycles. For that reason, if I had to choose between getting a midcycle test during the day or one during the pm cycle, i'd choose the pm cycle - since you're going to be aggressive with dosing because she's so high, i'd just want to be certain she's not dropping low in that pm cycle at some point. The way she looks right now, I'd want to increase every 4 cycles until you're seeing some blues.
From the
Tilly Diabetes Homepage (same protocol, some different wording):
However, if the cat is producing continuously high BGs (nadir always >=300 mg/dl), only hold the dose for 2-3 days before increasing it by 0.5 IU. Alternatively, if the cat is continuously producing moderately elevated BGs (nadir always >=200 mg/dl), increase the dose every 2-3 days by 0.25 IU ( if the cat is getting a low dose) or 0.5 IU (if the cat is getting a higher dose). From this point onward test for ketones once per week, or more often if the nadirs are still >=200 mg/dl.
(she is getting a "low" dose as far as the guidelines above go.)
In the meantime, I think continuing to look at what's making her so high would be worthwhile. If she fits the descriptions in the pancreatitis section, I'd ask for a spec fPL test (note you have to fast her for several hours first). If not, I'd explore with the vet what might be making her vomit.
Is there any possibility the boxes aren't clean enough for her? some cats can be incredibly finicky about that. Maybe all fresh litter would be worth trying. Also, i think you said she was checked for a urinary tract infection, but there is always the possibility of sterile cystitis, which is an inflammation, rather than an infection. It causes pain and can cause inappropriate urinating, like she's doing. Antibiotics don't help because it's not an infection. Same link as above, but scroll to the very bottom section of interesting posts, one of the last ones is a post on UTI's by Dr. Lisa. She talks about sterile cystitis as well in it. Are you adding lots of water to her food to help dilute the urine's acidity so it hopefully doesn't hurt her as much? Also, cosequin can help heal the lining of the bladder so it isn't so sensitive - if you aren't already giving her that, it might be worth trying.
Good luck - i know how worrisome it is when your beloved little one has high numbers and isn't doing well. Sending our best healing thoughts to Lee Lu and a big hug to you, Amanda!
ps - i didn't know you were in seattle - i'm between Salem & Eugene. foggy today!
